01X54Z4
Transfer Median Nerve to Ulnar Nerve with No Device, Percutaneous Endoscopic Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | 1 Peripheral Nervous System |
| Operation | X Transfer |
| Body Part | 5 Median Nerve |
| Approach | 4 Percutaneous Endoscopic |
| Device | Z No Device |
| Qualifier | 4 Ulnar Nerve |
Operation Definition
Moving, without taking out, all or a portion of a body part to another location to take over the function of all or a portion of a body part
Procedure Overview
Transfer procedures on the peripheral nervous system move a nerve, still attached to its original blood and nerve supply at one end, to a new location so it can take over the function of a different, nonworking nerve. Nerve transfers are used after severe injuries, such as brachial plexus avulsions, when the original nerve supplying a muscle is damaged beyond repair but a healthy, less critical nerve nearby can be redirected to reinnervate that muscle instead. A common example is transferring a branch of the spinal accessory nerve to the suprascapular nerve to restore shoulder function after a brachial plexus injury.
Because the donor nerve is not cut free entirely but repositioned to connect with a different target, these procedures differ from a graft, which uses a separate, disconnected piece of tissue to bridge a gap. Transfer is chosen specifically when restoring the original damaged nerve directly is not feasible.
Anatomy & Axis Detail
Median Nerve
Median nerve transfer typically involves harvesting a redundant motor fascicle, most often the branch to flexor carpi radialis or flexor digitorum superficialis, to reinnervate a target such as the axillary or musculocutaneous nerve in the setting of brachial plexus injury with a functioning median nerve. The median nerve runs centrally through the forearm supplying most flexor-pronator muscles and palmar sensation, so donor fascicle selection must avoid fibers essential to thumb opposition and precision grip. Surgeons rely on preoperative electrodiagnostic mapping and intraoperative nerve stimulation to confirm which fascicles are expendable before transecting and coapting them to the recipient nerve stump. Because the median nerve can also serve as a recipient in other reconstructive patterns, documentation should specify whether it functioned as donor or recipient tissue in the transfer.
Approach: Percutaneous Endoscopic
Percutaneous Endoscopic combines a puncture through skin or mucous membrane with insertion of an endoscope to visualize the procedure internally, as in laparoscopic cholecystectomy. It is distinguished from plain Percutaneous by the presence of scope-guided visualization, and from Via Natural or Artificial Opening Endoscopic by its route being a new puncture rather than an existing orifice or stoma.
Qualifier: Ulnar Nerve
The Ulnar Nerve runs along the medial forearm and hand, supplying most intrinsic hand muscles and sensation to the little finger and part of the ring finger; it is the nerve responsible for the "funny bone" sensation at the elbow. As a qualifier it distinguishes this nerve from the median and radial nerves, its companions in the upper extremity, when specifying the target of a procedure.
Coding & Documentation
The operative note needs to name both the donor nerve being moved and the recipient nerve or muscle it is being connected to, since the body part value coded reflects the nerve being transferred, not the target. A frequent coding error is mistaking a nerve transfer for a nerve graft repair; the distinguishing detail is whether the donor nerve retains its native blood supply and proximal attachment (Transfer) or is a free segment used to bridge a gap in a different nerve (Repair or Replacement). Coders should also check whether the transferred nerve is being coapted directly to the recipient nerve or routed through a graft, which can mean an additional code is warranted.